Healthcare Provider Details

I. General information

NPI: 1275646598
Provider Name (Legal Business Name): CENTRALIA ANESTHESIOLOGY SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PLEASANT AVE
CENTRALIA IL
62801-3056
US

IV. Provider business mailing address

4227 LINCOLNSHIRE DR
MOUNT VERNON IL
62864-2157
US

V. Phone/Fax

Practice location:
  • Phone: 618-436-5521
  • Fax: 618-436-8036
Mailing address:
  • Phone: 618-242-2317
  • Fax: 618-242-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number42618797
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number42618797
License Number StateIL

VIII. Authorized Official

Name: FRANK M EATON
Title or Position: PRESIDENT
Credential: MD
Phone: 618-241-1108